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CONNECTICUT CVS PHARMACY, L.L.C.
RRC070024-00 THE WILLIAM W. BACKUS HOSPITAL
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Covered Entity Details
Entity Name
THE WILLIAM W. BACKUS HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC070024-00
Entity Address
326 WASHINGTON STREET
NORWICH, CT 06360
Medicare Provider Number
070024
Participating Start Date
4/1/2025
Last Recertification Date
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
CONNECTICUT CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02109
22 WINDSOR AVE
VERNON ROCKVILLE, CT 06066
Pharmacy Comments
Contract Details
Approval Date
10/13/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/13/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Anthony Mastroianni, Regional Vice President, Finance
(860) 889-8331 Ext: 2311
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/13/2022
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